A 70-Year-Old Man With Severe Hand Pain, Part 2

Introduction. As discussed in last month’s What’s the Take Home? article,¹ a 70-year-old man presented to urgent care for severe pain of the right hand. The pain started one day earlier on the dorsum of his right hand and became severe overnight, as did the patient’s marked fatigue and lassitude.

Two to 3 days earlier, the patient and his friends had been catching crabs in the Chesapeake Bay and placing them in baskets as part of their summer vacation. No one else in the group contracted an illness. The patient took acetaminophen prior to his presentation for the pain, with no real effect.

Patient history. Although his medical history was negative for major diagnoses, he was diagnosed with Hepatitis C at 58 years of age as part of a screening program for veterans exposed to intravenous (IV) drug use when younger. At that time, a liver biopsy showed mild cirrhosis. He received an anti-viral and has tested negative for Hepatitis C ever since. His liver functions were generally normal 1 year ago.

In last month’s What’s the Take Home? article, necrotizing fasciitis had been suspected, prompting surgical exploration and debridement, which confirmed the diagnosis. Still, the patient remained ill with IV fluids and antibiotics in place. Following the debridement, the patient’s fever reached 100.8 F with significant lassitude and fatigue. His blood pressure was 105/75. Ongoing drainage from the wound continued.

(Answer and discussion on the next page).